The United States has almost no rules when it comes to buying or selling sperm. In fact, no one keeps records on how much sperm is bought or sold, so we don’t even know how big the sperm market really is, or how many babies are born each year through donor sperm. The same donor can father hundreds of children, and, although his sperm must undergo some minimal testing before it is used, these tests don’t catch many genetic diseases. No laws in the United States require that donors or recipients exchange any information, identifying or otherwise.

Most people don’t think about these issues. Nonetheless, more than 2 million married women in the U.S. today struggle with infertility because of a medical inability to conceive, and thousands of single women and men, same-sex couples, and lesbian and gay individuals are biologically unable to conceive children without egg or sperm donors. They are supported by a large, consumer-driven business that has resisted additional regulation.

Ultimately, however, if we value children and their families, reform and regulation must occur. Three sets of reforms provide the basis for changing the donor world. First, the U.S. should establish a databank on assisted reproductive technology. The government should require the collection of additional information from all clinics and sperm banks, including record-keeping on all donors, reporting any births from donor gametes, and updating and sharing medical information between donors, recipients and donor-conceived people.

Second, like other countries, the U.S. should impose limits on the number of children born through one donor’s sperm. This might mean, as in Britain, letting only up to 10 families use one donor’s sperm. Research has shown that some sperm donors donate to more than one facility, so this requires better tracking of donors.

Finally, and most radically, the United States should follow in the footsteps of numerous other countries, which allow for limited disclosure of the donor’s identity. This involves reconsidering the practice of donor anonymity, which prevents most donor-conceived people from ever finding out about their biological and genetic heritages, and asking instead: Is it fair to bring children into the world who don’t have the chance to know about their ancestry and their medical background?